33 results on '"Makombe S"'
Search Results
2. Development and Validation of a Global Positioning System-based 'Map Book' System for Categorizing Cluster Residency Status of Community Members Living in High-Density Urban Slums in Blantyre, Malawi
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MacPherson, Peter, Choko, A. T., Webb, E. L., Thindwa, D., Squire, Bertie, Sambakunsi, R., van Oosterhout, J. J., Chunda, T., Chavula, K., Makombe, S. D., Lalloo, David, and Corbett, E. L.
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wa_950 ,qv_771 ,wa_395 - Abstract
A significant methodological challenge in implementing community-based cluster-randomized trials is how to accurately categorize cluster residency when data are collected at a site distant from households. This study set out to validate a map book system for use in urban slums with no municipal address systems, where classification has been shown to be inaccurate when address descriptions were used. Between April and July 2011, 28 noncontiguous clusters were demarcated in Blantyre, Malawi. In December 2011, antiretroviral therapy initiators were asked to identify themselves as cluster residents (yes/no and which cluster) by using map books. A random sample of antiretroviral therapy initiators was used to validate map book categorization against Global Positioning System coordinates taken from participants' households. Of the 202 antiretroviral therapy initiators, 48 (23.8%) were categorized with the map book system as in-cluster residents and 147 (72.8%) as out-of-cluster residents, and 7 (3.4%) were unsure. Agreement between map books and the Global Positioning System was 100% in the 20 adults selected for validation and was 95.0% (κ = 0.96, 95% confidence interval: 0.84, 1.00) in an additional 20 in-cluster residents (overall κ = 0.97, 95% confidence interval: 0.90, 1.00). With map books, cluster residents were classified rapidly and accurately. If validated elsewhere, this approach could be of widespread value in that it would enable accurate categorization without home visits.
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- 2013
3. Prevention of mother-to-child transmission of HIV and the health-related Millennium Development Goals: time for a public health approach
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Schouten, E. J., Jahn, A., Midiani, D., Makombe, S. D., Mnthambala, A., Chirwa, Z., Harries, A. D., Oosterhout, J. J., Meguid, T., Ben-Smith, A., Zachariah, R., Lynen, L., Zolfo, M., Damme, W., Charles Gilks, Atun, R., Shawa, M., Chimbwandira, F., and Gerontology
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Settings ,africa ,public health ,HIV ,Initiation ,cohort ,Antiretroviral therapy - Abstract
No abstract available
- Published
- 2011
4. Treatment Initiation, Program Attrition and Patient Treatment Outcomes Associated with Scale-Up and Decentralization of HIV Care in Rural Malawi.
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Munyenyembe T., Huckabee M., Pujades-Rodriguez M., Heinzelmann A., Szumilin E., McGuire M., Makombe S., Pinoges L., Kanapathipillai R., Munyenyembe T., Huckabee M., Pujades-Rodriguez M., Heinzelmann A., Szumilin E., McGuire M., Makombe S., Pinoges L., and Kanapathipillai R.
- Abstract
Objective: To describe patient antiretroviral therapy (cART) outcomes associated with intensive decentralization of services in a rural HIV program in Malawi. Method(s): Longitudinal analysis of data from HIV-infected patients starting cART between August 2001 and December 2008 and of a cross-sectional immunovirological assessment conducted 12 (+/-2) months after therapy start. One-year mortality, lost to follow-up, and attrition (deaths and lost to follow-up) rates were estimated with exact Poisson 95% confidence intervals (CI) by type of care delivery and year of initiation. Association of virological suppression (<50 copies/mL) and immunological success (CD4 gain >=100 cells/muL), with type of care was investigated using multiple logistic regression. Result(s): During the study period, 4322 cART patients received centralized care and 11,090 decentralized care. At therapy start, patients treated in decentralized health facilities had higher median CD4 count levels (167 vs. 130 cell/muL, P<0.0001) than other patients. Two years after cART start, program attrition was lower in decentralized than centralized facilities (9.9 per 100 person-years, 95% CI: 9.5-10.4 vs. 20.8 per 100 person-years, 95% CI: 19.7-22.0). One year after treatment start, differences in immunological success (adjusted OR = 1.23, 95% CI: 0.83-1.83), and viral suppression (adjusted OR = 0.80, 95% CI: 0.56-1.14) between patients followed at centralized and decentralized facilities were not statistically significant. Conclusion(s): In rural Malawi, 1- and 2-year program attrition was lower in decentralized than in centralized health facilities and no statistically significant differences in one-year immunovirological outcomes were observed between the two health care levels. Longer follow-up is needed to confirm these results. © 2012 McGuire et al.
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- 2012
5. Sulfonic acid-functionalized polyallylamine (sevelamer) as an efficient reusable strong solid acid catalyst for the synthesis of xanthenes derivatives
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Xian-Liang Zhao, Makombe Shelton, and Ke-Fang Yang
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Sevelamer ,Sulfonic acid ,1,8-Dioxo-octahydroxanthene ,Recycle ,Water ,Chemistry ,QD1-999 - Abstract
Abstract Sevelamer (polyallyamine resin)-supported sulfonic acid (S-SO3H) has been prepared from the reaction of sevelamer with chlorosulfonic acid and characterized using FT-IR spectroscopy, scanning electronmicroscopy (SEM) and thermogravimetric analysis (TGA). The catalytic activity of S-SO3H was investigated in the synthesis of 1,8-dioxo-octahydroxanthene derivatives. All of the reactions were fast and gave excellent yields. The catalyst was easily recovered and reused for 5 runs without significant loss of its catalytic activity.
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- 2019
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6. Who is accessing antiretroviral therapy in Malawi? study in the Southern Region on the occupation category “other”
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Teferra, T B, primary, Hochgesang, M, additional, Makombe, S D, additional, Kamoto, K, additional, and Harries, AD, additional
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- 2008
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7. An audit of how patients get on to antiretroviral therapy in Malawi, and the weight gain they experience in the first six months
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Bizuwork, T, primary, Makombe, S D, additional, Kamoto, K, additional, Hochgesang, M, additional, and Harries, A D, additional
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- 2008
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8. Providing insecticide treated bed nets in antiretroviral treatment clinics in Malawi: a pilot study
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Makombe, S D, primary, Lowrance, D W, additional, Kamoto, K, additional, Kabuluzi, S, additional, Zoya, J, additional, Schouten, E J, additional, Bizuneh, K, additional, and Harries, A D, additional
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- 2008
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9. Lessons from the field. Supervision, monitoring and evaluation of nationwide scale-up of antiretroviral therapy in Malawi.
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Libamba E, Makombe S, Mhango E, de Ascurra Teck O, Limbambala E, Schouten EJ, and Harries AD
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OBJECTIVE: To describe the supervision, monitoring and evaluation strategies used to assess the delivery of antiretroviral therapy during nationwide scale-up of treatment in Malawi. METHODS: In the first quarter of 2005, the HIV Unit of the Ministry of Health and its partners (the Lighthouse Clinic; Medecins Sans Frontieres-Belgium, Thyolo district; and WHO's Country Office) undertook structured supervision and monitoring of all public sector health facilities in Malawi delivering antiretroviral therapy. FINDINGS: Data monitoring showed that by the end of 2004, there were 13,183 patients (5274 (40%) male, 12 527 (95%) adults) who had ever started antiretroviral therapy. Of patients who had ever started, 82% (10 761/13,183) were alive and taking antiretrovirals; 8% (1026/13,183) were dead; 8% (1039/13,183) had been lost to follow up; <1% (106/13,183) had stopped treatment; and 2% (251/13,183) had transferred to another facility. Of those alive and on antiretrovirals, 98% (7098/7258) were ambulatory; 85% (6174/7258) were fit to work; 10% (456/4687) had significant side effects; and, based on pill counts, 96% (6824/7114) had taken their treatment correctly. Mistakes in the registration and monitoring of patients were identified and corrected. Drug stocks were checked, and one potential drug stock-out was averted. As a result of the supervisory visits, by the end of March 2005 recruitment of patients to facilities scheduled to start delivering antiretroviral therapy had increased. CONCLUSION: This report demonstrates the importance of early supervision for sites that are starting to deliver antiretroviral therapy, and it shows the value of combining data collection with supervision. Making regular supervisory and monitoring visits to delivery sites are essential for tracking the national scale-up of delivery of antiretrovirals. Copyright © 2005 World Health Organization [ABSTRACT FROM AUTHOR]
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- 2006
10. Impact of an Innovative Approach to Prevent Mother-to-Child Transmission of HIV - Malawi, July 2011-September 2012
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Chimbwandira, F., Mhango, E., Makombe, S., Midiani, D., Mwansambo, C., Njala, J., Chirwa, Z., Andreas Jahn, Schouten, E., Phelps, B. R., Gieselman, A., Holmes, C. B., Maida, A., Gupta, S., Barr, B. A. T., Modi, S., Dale, H., Aberle-Grasse, J., Davis, M., Bell, D., and Houston, J.
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Adult ,Malawi ,Health Personnel ,Infant, Newborn ,Eligibility Determination ,HIV Infections ,Articles ,World Health Organization ,Health Services Accessibility ,Infectious Disease Transmission, Vertical ,CD4 Lymphocyte Count ,Breast Feeding ,Anti-Retroviral Agents ,Pregnancy ,Humans ,Female ,Pregnancy Complications, Infectious ,Program Evaluation - Abstract
Antiretroviral medications can reduce rates of mother-to-child transmission of human immunodeficiency virus (HIV) to less than 5%. However, in 2011, only 57% of HIV-infected pregnant women in low- and middle-income countries received a World Health Organization (WHO)-recommended regimen for prevention of mother-to-child transmission (PMTCT), and an estimated 300,000 infants acquired HIV infection from their mothers in sub-Saharan Africa; 15,700 (5.2%) of these infants were born in Malawi. An important barrier to PMTCT in Malawi is the limited laboratory capacity for CD4 cell count, which is recommended by WHO to determine which antiretroviral medications to start. In the third quarter of 2011, the Malawi Ministry of Health (MOH) implemented an innovative approach (called "Option B+"), in which all HIV-infected pregnant and breastfeeding women are eligible for lifelong antiretroviral therapy (ART) regardless of CD4 count. Since that time, several countries (including Rwanda, Uganda, and Haiti) have adopted the Option B+ policy, and WHO was prompted to release a technical update in April 2012 describing the advantages and challenges of this approach as well as the need to evaluate country experiences with Option B+. Using data collected through routine program supervision, this report is the first to summarize Malawi's experience implementing Option B+ under the direction of the MOH and supported by the Office of the Global AIDS Coordinator (OGAC) through the President's Emergency Plan for AIDS Relief (PEPFAR). In Malawi, the number of pregnant and breastfeeding women started on ART per quarter increased by 748%, from 1,257 in the second quarter of 2011 (before Option B+ implementation) to 10,663 in the third quarter of 2012 (1 year after implementation). Of the 2,949 women who started ART under Option B+ in the third quarter of 2011 and did not transfer care, 2,267 (77%) continue to receive ART at 12 months; this retention rate is similar to the rate for all adults in the national program. Option B+ is an important innovation that could accelerate progress in Malawi and other countries toward the goal of eliminating mother-to-child transmission of HIV worldwide.
11. Supervision, monitoring and evaluation of nationwide scale-up of antiretroviral therapy in Malawi
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Libamba Edwin, Makombe Simon, Mhango Eustice, Teck Olga de Ascurra, Limbambala Eddie, Schouten Erik J, and Harries Anthony D
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HIV infections/drug therapy ,Acquired immunodeficiency syndrome/drug therapy ,Anti-retroviral agents ,National health programs/organization and administration ,Program evaluation ,Malawi ,Public aspects of medicine ,RA1-1270 - Abstract
OBJECTIVE: To describe the supervision, monitoring and evaluation strategies used to assess the delivery of antiretroviral therapy during nationwide scale-up of treatment in Malawi. METHODS: In the first quarter of 2005, the HIV Unit of the Ministry of Health and its partners (the Lighthouse Clinic; Médecins Sans Frontières-Belgium, Thyolo district; and WHO's Country Office) undertook structured supervision and monitoring of all public sector health facilities in Malawi delivering antiretroviral therapy. FINDINGS: Data monitoring showed that by the end of 2004, there were 13 183 patients (5274 (40%) male, 12 527 (95%) adults) who had ever started antiretroviral therapy. Of patients who had ever started, 82% (10 761/13 183) were alive and taking antiretrovirals; 8% (1026/13 183) were dead; 8% (1039/13 183) had been lost to follow up; < 1% (106/13 183) had stopped treatment; and 2% (251/13 183) had transferred to another facility. Of those alive and on antiretrovirals, 98% (7098/7258) were ambulatory; 85% (6174/7258) were fit to work; 10% (456/4687) had significant side effects; and, based on pill counts, 96% (6824/7114) had taken their treatment correctly. Mistakes in the registration and monitoring of patients were identified and corrected. Drug stocks were checked, and one potential drug stock-out was averted. As a result of the supervisory visits, by the end of March 2005 recruitment of patients to facilities scheduled to start delivering antiretroviral therapy had increased. CONCLUSION: This report demonstrates the importance of early supervision for sites that are starting to deliver antiretroviral therapy, and it shows the value of combining data collection with supervision. Making regular supervisory and monitoring visits to delivery sites are essential for tracking the national scale-up of delivery of antiretrovirals.
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- 2006
12. Improving data quality and supervision of antiretroviral therapy sites in Malawi: an application of Lot Quality Assurance Sampling
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Hedt-Gauthier Bethany L, Tenthani Lyson, Mitchell Shira, Chimbwandira Frank M, Makombe Simon, Chirwa Zengani, Schouten Erik J, Pagano Marcello, and Jahn Andreas
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HIV treatment programs ,Malawi ,Africa ,Supervision ,Data quality ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background High quality program data is critical for managing, monitoring, and evaluating national HIV treatment programs. By 2009, the Malawi Ministry of Health had initiated more than 270,000 patients on HIV treatment at 377 sites. Quarterly supervision of these antiretroviral therapy (ART) sites ensures high quality care, but the time currently dedicated to exhaustive record review and data cleaning detracts from other critical components. The exhaustive record review is unlikely to be sustainable long term because of the resources required and increasing number of patients on ART. This study quantifies the current levels of data quality and evaluates Lot Quality Assurance Sampling (LQAS) as a tool to prioritize sites with low data quality, thus lowering costs while maintaining sufficient quality for program monitoring and patient care. Methods In January 2010, a study team joined supervision teams at 19 sites purposely selected to reflect the variety of ART sites. During the exhaustive data review, the time allocated to data cleaning and data discrepancies were documented. The team then randomly sampled 76 records from each site, recording secondary outcomes and the time required for sampling. Results At the 19 sites, only 1.2% of records had discrepancies in patient outcomes and 0.4% in treatment regimen. However, data cleaning took 28.5 hours in total, suggesting that data cleaning for all 377 ART sites would require over 350 supervision-hours quarterly. The LQAS tool accurately identified the sites with the low data quality, reduced the time for data cleaning by 70%, and allowed for reporting on secondary outcomes. Conclusions Most sites maintained high quality records. In spite of this, data cleaning required significant amounts of time with little effect on program estimates of patient outcomes. LQAS conserves resources while maintaining sufficient data quality for program assessment and management to allow for quality patient care.
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- 2012
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13. Operational research in malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV
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Schouten Erik J, Kanyerere Henry, Gausi Francis, Salaniponi Felix, Chimzizi Rhehab, Zachariah Rony, Harries Anthony D, Jahn Andreas, Makombe Simon D, Chimbwandira Frank M, and Mpunga James
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Operational research ,cotrimoxazole preventive therapy ,tuberculosis ,HIV/AIDS ,Malawi ,Africa ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively. This article i) discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, ii) outlines the steps that were taken to translate these findings into national policy and practice, iii) shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and iv) highlights lessons that can be learnt for other settings and interventions. Discussion District and facility-based operational research was undertaken between 1999 and 2005 to assess the effectiveness of cotrimoxazole preventive therapy in reducing death rates in TB patients and subsequently in patients starting ART under routine programme conditions. Studies demonstrated significant reductions in case fatality in HIV-infected TB patients receiving cotrimoxazole and in HIV-infected patients about to start ART. Following the completion of research, the findings were rapidly disseminated nationally at stakeholder meetings convened by the Ministry of Health and internationally through conferences and peer-reviewed scientific publications. The Ministry of Health made policy changes based on the available evidence, following which there was countrywide distribution of the updated policy and guidelines. Policy was rapidly moved to practice with the development of monitoring tools, drug procurement and training packages. National programme performance improved which showed a significant decrease in case fatality rates in TB patients as well as a reduction in early death in people with HIV starting ART. Summary Key lessons for moving this research endeavour through to policy and practice were the importance of placing operational research within the programme, defining relevant questions, obtaining "buy-in" from national programme staff at the beginning of projects and having key actors or "policy entrepreneurs" to push forward the policy-making process. Ultimately, any change in policy and practice has to benefit patients, and the ultimate judge of success is whether treatment outcomes improve or not.
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- 2011
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14. HIV policy and implementation: a national policy review and an implementation case study of a rural area of northern Malawi.
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Dasgupta AN, Wringe A, Crampin AC, Chisambo C, Koole O, Makombe S, Sungani C, Todd J, and Church K
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- Adult, Female, HIV Infections prevention & control, Humans, Malawi, Male, Rural Population, HIV Infections diagnosis, HIV Infections therapy, Health Policy legislation & jurisprudence, Rural Health Services
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Malawi is a global leader in the design and implementation of progressive HIV policies. However, there continues to be substantial attrition of people living with HIV across the "cascade" of HIV services from diagnosis to treatment, and program outcomes could improve further. Ability to successfully implement national HIV policy, especially in rural areas, may have an impact on consistency of service uptake. We reviewed Malawian policies and guidelines published between 2003 and 2013 relating to accessibility of adult HIV testing, prevention of mother-to-child transmission and HIV care and treatment services using a policy extraction tool, with gaps completed through key informant interviews. A health facility survey was conducted in six facilities serving the population of a demographic surveillance site in rural northern Malawi to investigate service-level policy implementation. Survey data were analyzed using descriptive statistics. Policy implementation was assessed by comparing policy content and facility practice using pre-defined indicators covering service access: quality of care, service coordination and patient tracking, patient support, and medical management. ART was rolled out in Malawi in 2004 and became available in the study area in 2005. In most areas, practices in the surveyed health facilities complied with or exceeded national policy, including those designed to promote rapid initiation onto treatment, such as free services and task-shifting for treatment initiation. However, policy and/or practice were/was lacking in certain areas, in particular those strategies to promote retention in HIV care (e.g., adherence monitoring and home-based care). In some instances, though, facilities implemented alternative progressive practices aimed at improving quality of care and encouraging adherence. While Malawi has formulated a range of progressive policies aiming to promote rapid initiation onto ART, increased investment in policy implementation strategies and quality service delivery, in particular to promote long-term retention on treatment may improve outcomes further.
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- 2016
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15. Strategies for monitoring and evaluation of resource-limited national antiretroviral therapy programs: the two-phase design.
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Haneuse S, Hedt-Gauthier B, Chimbwandira F, Makombe S, Tenthani L, and Jahn A
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- Adolescent, Adult, Aged, Cost-Benefit Analysis, Delivery of Health Care economics, Delivery of Health Care methods, Female, HIV Infections epidemiology, Health Resources economics, Health Resources supply & distribution, Humans, Logistic Models, Malawi epidemiology, Male, Middle Aged, Outcome Assessment, Health Care economics, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care statistics & numerical data, Young Adult, Anti-Retroviral Agents therapeutic use, Disease Outbreaks prevention & control, HIV Infections drug therapy, Program Evaluation methods
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Background: In resource-limited settings, monitoring and evaluation (M&E) of antiretroviral treatment (ART) programs often relies on aggregated facility-level data. Such data are limited, however, because of the potential for ecological bias, although collecting detailed patient-level data is often prohibitively expensive. To resolve this dilemma, we propose the use of the two-phase design. Specifically, when the outcome of interest is binary, the two-phase design provides a framework within which researchers can resolve ecological bias through the collection of patient-level data on a sub-sample of individuals while making use of the routinely collected aggregated data to obtain potentially substantial efficiency gains., Methods: Between 2005-2007, the Malawian Ministry of Health conducted a one-time cross-sectional survey of 82,887 patients registered at 189 ART clinics. Using these patient data, an aggregated dataset is constructed to mimic the type of data that it routinely available. A hypothetical study of risk factors for patient outcomes at 6 months post-registration is considered. Analyses are conducted based on: (i) complete patient-level data; (ii) aggregated data; (iii) a hypothetical case-control study; (iv) a hypothetical two-phase study stratified on clinic type; and, (v) a hypothetical two-phase study stratified on clinic type and registration year. A simulation study is conducted to compare statistical power to detect an interaction between clinic type and year of registration across the designs., Results: Analyses and conclusions based solely on aggregated data may suffer from ecological bias. Collecting and analyzing patient data using either a case-control or two-phase design resolves ecological bias to provide valid conclusions. To detect the interaction between clinic type and year of registration, the case-control design would require a prohibitively large sample size. In contrast, a two-phase design that stratifies on clinic and year of registration achieves greater than 85% power with as few as 1,000 patient samples., Conclusions: Two-phase designs have the potential to augment current M&E efforts in resource-limited settings by providing a framework for the collection and analysis of patient data. The design is cost-efficient in the sense that it often requires far fewer patients to be sampled when compared to standard designs.
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- 2015
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16. Task-sharing of HIV care and ART initiation: evaluation of a mixed-care non-physician provider model for ART delivery in rural Malawi.
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McGuire M, Ben Farhat J, Pedrono G, Szumilin E, Heinzelmann A, Chinyumba YN, Goossens S, Makombe S, and Pujades-Rodríguez M
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- Adult, Female, Humans, Malawi, Male, Treatment Outcome, Anti-HIV Agents therapeutic use, Delivery of Health Care statistics & numerical data, HIV Infections drug therapy
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Background: Expanding access to antiretroviral therapy (ART) in sub-Saharan Africa requires implementation of alternative care delivery models to traditional physician-centered approaches. This longitudinal analysis compares outcomes of patients initiated on antiretroviral therapy (ART) by non-physician and physician providers., Methods: Adults (≥15 years) initiating ART between September 2007 and March 2010, and with >1 follow-up visit were included and classified according to the proportion of clinical visits performed by nurses or by clinical officers (≥ 80% of visits). Multivariable Poisson models were used to compare 2-year program attrition (mortality and lost to follow-up) and mortality by type of provider. In sensitivity analyses only patients with less severe disease were included., Results: A total of 10,112 patients contributed 14,012 person-years to the analysis: 3386 (33.5%) in the clinical officer group, 1901 (18.8%) in the nurse care group and 4825 (47.7%) in the mixed care group. Overall 2-year program retention was 81.8%. Attrition was lower in the mixed care and higher in the clinical officer group, compared to the nurse group (adjusted incidence rate ratio [aIRR]=0.54, 95%CI 0.45-0.65; and aIRR=3.03, 95%CI 2.56-3.59, respectively). While patients initiated on ART by clinical officers in the mixed care group had lower attrition (aIRR=0.36, 95%CI 0.29-0.44) than those in the overall nurse care group; no differences in attrition were found between patients initiated on ART by nurses in the mixed care group and those included in the nurse group (aIRR=1.18, 95%CI 0.95-1.47). Two-year mortality estimates were aIRR=0.72, 95%CI 0.49-1.09 and aIRR=5.04, 95%CI 3.56-7.15, respectively. Slightly higher estimates were observed when analyses were restricted to patients with less severe disease., Conclusion: The findings of this study support the use of a mixed care model with well trained and regularly supervised nurses and medical assistants to provide HIV care in countries with high HIV prevalence.
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- 2013
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17. Mortality and loss to follow-up in the first year of ART: Malawi national ART programme.
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Weigel R, Estill J, Egger M, Harries AD, Makombe S, Tweya H, Jahn A, and Keiser O
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- Adolescent, Adult, CD4 Lymphocyte Count, Child, Child, Preschool, Cohort Studies, Female, Follow-Up Studies, HIV Infections drug therapy, HIV Infections economics, Health Services Accessibility economics, Humans, Incidence, Infant, Infant, Newborn, Malawi epidemiology, Male, Middle Aged, Risk Factors, Sex Distribution, Young Adult, Anti-HIV Agents therapeutic use, HIV Infections mortality, Health Services Accessibility statistics & numerical data, Lost to Follow-Up, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Objectives: To analyse mortality, loss to follow-up (LTFU) and retention on antiretroviral treatment (ART) in the first year of ART across all age groups in the Malawi national ART programme., Design: Cohort study including all patients who started ART in Malawi's public sector clinics between 2004 and 2007., Methods: ART registers were photographed, information entered into a database and merged with data from clinics with electronic records. Rates per 100 patient-years and cumulative incidence of retention were calculated. Subhazard ratios (sHRs) of outcomes adjusted for patient and clinic-level characteristics were calculated in multivariable analysis, applying competing risk models., Results: A total of 117,945 patients contributed 85,246 person-years: 1.0% were infants below 2 years, 7.4% children 2-14, 7.5% young people 15-24, and 84.2% adults 25 years and above. Sixty percent of patients were female: women outnumbered men from age 14 to 35 years. Mortality and LTFU were higher in men from age 20 years. Infants and young people had the highest rates per 100 person-years for mortality (23.0 and 19.4) and LTFU (24.7 and 19.3), and the highest adjusted relative risks compared to age group 25-34 years: sHRs were 1.37 [95% confidence interval (CI) 1.17-1.60] and 1.17 (95% CI 1.10-1.25) for death and 1.37 (95% CI 1.18-1.59) and 1.27 (95% CI 1.19-1.35) for LTFU, respectively., Conclusion: In this country-wide study patients aged 0-1 and 15-24 years had the highest risk of death and LTFU, and from age 20 men were at higher risk than women. Interventions to improve outcomes in these patient groups are required.
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- 2012
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18. Treatment initiation, program attrition and patient treatment outcomes associated with scale-up and decentralization of HIV care in rural Malawi.
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McGuire M, Pinoges L, Kanapathipillai R, Munyenyembe T, Huckabee M, Makombe S, Szumilin E, Heinzelmann A, and Pujades-Rodríguez M
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- Adult, CD4 Lymphocyte Count, Female, HIV Infections mortality, Humans, Longitudinal Studies, Malawi epidemiology, Male, Middle Aged, Patient Dropouts, Retrospective Studies, Risk Factors, Treatment Outcome, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, Rural Health Services organization & administration, Rural Population
- Abstract
Objective: To describe patient antiretroviral therapy (cART) outcomes associated with intensive decentralization of services in a rural HIV program in Malawi., Methods: Longitudinal analysis of data from HIV-infected patients starting cART between August 2001 and December 2008 and of a cross-sectional immunovirological assessment conducted 12 (±2) months after therapy start. One-year mortality, lost to follow-up, and attrition (deaths and lost to follow-up) rates were estimated with exact Poisson 95% confidence intervals (CI) by type of care delivery and year of initiation. Association of virological suppression (<50 copies/mL) and immunological success (CD4 gain ≥100 cells/µL), with type of care was investigated using multiple logistic regression., Results: During the study period, 4322 cART patients received centralized care and 11,090 decentralized care. At therapy start, patients treated in decentralized health facilities had higher median CD4 count levels (167 vs. 130 cell/µL, P<0.0001) than other patients. Two years after cART start, program attrition was lower in decentralized than centralized facilities (9.9 per 100 person-years, 95% CI: 9.5-10.4 vs. 20.8 per 100 person-years, 95% CI: 19.7-22.0). One year after treatment start, differences in immunological success (adjusted OR=1.23, 95% CI: 0.83-1.83), and viral suppression (adjusted OR=0.80, 95% CI: 0.56-1.14) between patients followed at centralized and decentralized facilities were not statistically significant., Conclusions: In rural Malawi, 1- and 2-year program attrition was lower in decentralized than in centralized health facilities and no statistically significant differences in one-year immunovirological outcomes were observed between the two health care levels. Longer follow-up is needed to confirm these results.
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- 2012
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19. Is transcription of data on antiretroviral treatment from electronic to paper-based registers reliable in Malawi?
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Gadabu OJ, Munthali CV, Zachariah R, Gudmund-Hinderaker S, Jahn A, Twea H, Gondwe A, Mumba S, Lungu M, Malisita K, Mhango E, Makombe SD, Tenthani L, Mwalwanda L, Moyo C, Douglas GP, Lewis ZL, and Chimbwandira F
- Abstract
Setting: Antiretroviral treatment (ART) clinics at one central hospital, three district hospitals and one mission hospital in the central and southern regions of Malawi., Objective: To measure the extent of inaccuracies in the transcription of case registration and recorded deaths between electronic medical data (EMR) and paper registers. This was done to inform the Ministry of Health on the reliability of the paper-based system as backup in case of EMR failure., Design: Retrospective analysis of routine programme data., Results: A total of 31 763 registrations and 2922 deaths in the EMR were compared with those in the paper registers. In one hospital, up to 24% of overall case registrations were missing from the paper registers. At other sites, the differences were minor and included duplicate patients who should have been classified as 'transfer in' patients in the paper register. There were major differences in the number of registered deaths in two of the five facilities., Conclusion: There are varying degrees of agreement between the EMR and paper registers which compromise the use of the latter as a backup solution in case of EMR failure. The reasons for this unreliability and ways forward to address the problem are discussed.
- Published
- 2011
- Full Text
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20. A public health approach to rapid scale-up of antiretroviral treatment in Malawi during 2004-2006.
- Author
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Lowrance DW, Makombe S, Harries AD, Shiraishi RW, Hochgesang M, Aberle-Grasse J, Libamba E, Schouten E, Ellerbrock T, and Kamoto K
- Subjects
- Acquired Immunodeficiency Syndrome mortality, Adolescent, Adult, Aged, Female, Humans, Malawi, Male, Middle Aged, Time Factors, Treatment Outcome, Acquired Immunodeficiency Syndrome drug therapy, Anti-HIV Agents therapeutic use, Public Health
- Abstract
Background: Approximately 1 million people are infected with HIV in Malawi, where AIDS is the leading cause of death in adults. By December 31, 2007, more than 141,000 patients were initiated on antiretroviral treatment (ART) by use of a public health approach to scale up HIV services., Methods: We analyzed national quarterly and longitudinal cohort data from October 2004 to December 2006 to examine trends in characteristics of patients initiating ART, end-of-quarter clinical outcomes, and 6- and 12-month survival probability., Findings: During a 27-month period, 72,666 patients were initiated on ART, of whom about two-thirds were women. The percentage of patients initiated on ART who were children and farmers increased from 5.5% to 9.0% and 23% to 32%, respectively (P < 0.001 for trends). Estimated survival probability ranged from 85% to 88% at 6 months and 81% to 84% at 12 months on ART., Interpretation: In Malawi, a public health approach to ART increased treatment access and maintained high 6- and 12-month survival. Resource-limited countries scaling up ART programs may benefit from this approach of simplified clinical decision making, standardized ART regimens, nonphysician care, limited laboratory support, and centralized monitoring and evaluation.
- Published
- 2008
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21. Outcomes in HIV-infected patients who develop tuberculosis after starting antiretroviral treatment in Malawi.
- Author
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Yu JK, Bong CN, Chen SC, Dzimadzi R, Lu DY, Makombe SD, Schouten EJ, Kamoto K, and Harries AD
- Subjects
- Anti-Retroviral Agents therapeutic use, Antitubercular Agents therapeutic use, Child, Comorbidity, HIV Infections drug therapy, HIV Infections mortality, Humans, Isoniazid therapeutic use, Malawi, Retrospective Studies, Treatment Outcome, Tuberculosis, Pulmonary mortality, HIV Infections epidemiology, Tuberculosis, Pulmonary epidemiology
- Abstract
A retrospective review was conducted of patients starting antiretroviral treatment (ART) at Mzuzu Central Hospital, Malawi, to identify those who developed tuberculosis (TB) within 6 months of commencing ART and document their treatment outcomes. Of 2933 patients, 22 (0.75%) developed active TB, 17 (77%) of whom had commenced ART as a result of unexplained weight loss and/or fever. Of those who developed TB, 41% successfully completed anti-tuberculosis treatment, with lower survival probabilities than patients who did not develop TB. Easier methods are needed to diagnose TB in human immunodeficiency virus-infected patients and to prevent patients from developing TB while on ART.
- Published
- 2008
22. Early warning indicators for HIV drug resistance in Malawi.
- Author
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Hedt BL, Wadonda-Kabondo N, Makombe S, Harries AD, Schouten EJ, Limbambala E, Hochgesang M, Aberle-Grosse J, and Kamoto K
- Subjects
- Anti-Retroviral Agents supply & distribution, HIV Infections epidemiology, HIV Infections virology, Humans, Malawi epidemiology, Patient Compliance, Patient Dropouts, Population Surveillance, Practice Patterns, Physicians', Program Evaluation, Registries, Time Factors, Treatment Outcome, World Health Organization, Anti-Retroviral Agents therapeutic use, Drug Resistance, Viral, HIV Infections drug therapy, National Health Programs statistics & numerical data
- Abstract
Background: Malawi started rapid scale-up of antiretroviral therapy (ART) in 2004 and by December 2006 had initiated over 85,000 patients on treatment. Early warning indicator (EWI) reports can help to minimize the risk of emerging drug resistance., Methods: Data collected during the routine quarterly supervision of 103 public sector sites was used to compile the first EWI report for HIV drug resistance (HIVDR) in Malawi, reflecting outcomes for October to December 2006., Results: All sites reach the World Health Organization (WHO) targets for prescribing practices and drug supply continuity. The target for adherence was achieved by 85% of sites and 84% achieved the target for minimizing treatment defaults; however, less than half of all sites reach the WHO target for patient retention., Conclusions: These results emphasize the importance of defaulter tracing and initiating treatment earlier in the course of HIV infection. As part of a comprehensive HIVDR monitoring programme, the Ministry of Health plans for on-going tracking of these indicators, as well as special data collection from the private sector. Plans are also underway to gather information on other recommended indicators that are not collected during routine supervision.
- Published
- 2008
23. Who is accessing antiretroviral therapy in Malawi? A study in the Southern Region on the occupation category "other".
- Author
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Teferra T, Hochgesang M, Makombe S, Kamoto K, and Harries A
- Abstract
As part of quarterly national reports on the scale up of antiretroviral therapy (ART), demographic and clinical characteristics are recorded including data on occupation. The largest occupational category is that of "other". As there is no information on the composition of the different occupations of patients placed in this category, a formal study was therefore conducted in 6 representative public sector facilities in the Southeastern Region of Malawi. Between January to June 2006, there were 126 adult patients recorded as "other" in the occupation column. A great variety of different occupations was recorded including no employment 30%, administration jobs 24%, general labourers 11%, builders 10%, tailors 9% and drivers 7%. A wide range of people with different jobs are accessing ART, and this should help in improving the economy of the patients as well as the country at large.
- Published
- 2007
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24. Lower early mortality rates among patients receiving antiretroviral treatment at clinics offering cotrimoxazole prophylaxis in Malawi.
- Author
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Lowrance D, Makombe S, Harries A, Yu J, Aberle-Grasse J, Eiger O, Shiraishi R, Marston B, Ellerbrock T, and Libamba E
- Subjects
- Adolescent, Adult, Aged, Cohort Studies, Dose-Response Relationship, Drug, Female, HIV Infections complications, Humans, Malawi epidemiology, Male, Middle Aged, Pneumonia, Pneumocystis prevention & control, Retrospective Studies, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, HIV Infections mortality, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use
- Abstract
Objective: To determine whether Malawi antiretroviral treatment (ART) clinics providing cotrimoxazole (CTX) prophylaxis had lower early mortality rates compared with clinics not providing CTX., Methods: Retrospective cohort study of eleven ART clinics in Malawi that were or were not providing CTX. Medical record abstraction was performed for all patients (N = 1295) initiating ART between July 1 and December 15, 2005. At 5 ART sites, CTX was given to patients dosed at 960 mg daily or 480 mg twice a day (according to national guidelines)., Results: When all defaults (patients lost to follow-up for >90 days) were excluded from the analysis, the 6-month mortality rate was 10.7% in patients receiving ART at CTX clinics compared with 18.0% in those not at CTX clinics (6-month mortality risk reduction = 40.7%; P = 0.0013). Kaplan-Meier survival curves for patients receiving CTX and patients not receiving CTX were significantly different; survival differences were apparent as early as 40 to 45 days after initiation of ART., Conclusions: Patients receiving ART in Malawi at clinics offering CTX prophylaxis had significantly reduced mortality during the first 6 months of ART. This additional intervention may have the potential to improve the lives of patients on ART, because CTX is readily available and relatively inexpensive and can, in principle, be easily introduced into ART delivery programs.
- Published
- 2007
25. Providing insecticide treated bed nets in antiretroviral treatment clinics in Malawi: a pilot study.
- Author
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Makombe S, Lowrance D, Kamoto K, Kabuluzi S, Zoya J, Schouten E, Bizuneh K, and Harries A
- Abstract
HIV infection and malaria, two of the most common and important health problems in sub-Saharan Africa, have been demonstrated to have interactive pathology. In Malawi, where malaria is endemic, and antiretroviral therapy (ART) delivery is scaling up, we piloted integration of long-lasting insecticide-treated bednets (ITN) provision in three ART clinics. In July 2006, 1,910 ITNs were delivered to pilot sites, and ART clinic staff personnel were briefed on ITN provision and use of a monitoring system. Sites were assessed using a structured questionnaire in December 2006. During the pilot period, 1,282 ITNs were distributed to patients. A large proportion (70%) of ART patients at these sites received pilot study ITNs. Site adherence to the monitoring system was variable. Seventeen patients were interviewed, 14 of whom were ART patients who had received ITNs; 11 of these (79%) had slept under the net the previous night. This pilot demonstrates the feasibility of ITN distribution to patients attending ART clinics in Malawi. Programmatic and policy considerations for national roll-out include the need to: 1) adopt a standardized monitoring system, 2) develop information, education, and communication materials, 3) develop in-service training for ART clinicians, and 4) identify systems for forecasting, procuring and distributing ITNs.
- Published
- 2007
- Full Text
- View/download PDF
26. Providing An audit of how patients get on to antiretroviral therapy in Malawi, and the weight gain they experience in the first six months.
- Author
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Bizuwork T, Makombe S, Kamoto K, Hochgesang M, and Harries A
- Abstract
An operational study was conducted in 6 public sector health facilities in the Southern Region of Malawi to determine a) drop-out rates during the referral process of patients to antiretroviral therapy (ART) and b) weight gained during the first 6 months in patients who were alive and on ART at that time. There were 738 adult HIV-infected eligible patients booked for group counseling, of whom 550 (74.5%) attended individual counseling and started ART. 16% of patients dropped out between booking and group counseling and 9.5% between group counseling and start of ART. In patients who were alive and on ART 6 months after starting, there was a gradual increase in weight with a mean gain of 6.0 kg in men and 5.0 kg in women. There was a slight increase in weight gain in patients in WHO Clinical Stage 3 and 4 compared with those in Stage 1&2, although this was only significant at 6-months between women in Stage 4 compared with women in Stage 1&2 (p <0.05). More information is needed on why patients drop out of the counseling process before starting ART, and whether weight gain is a marker for survival in the early months of ART.
- Published
- 2007
- Full Text
- View/download PDF
27. Outcomes of HIV-infected children with tuberculosis who are started on antiretroviral therapy in Malawi.
- Author
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Bong CN, Chen SC, Jong YJ, Tok TS, Hsu CF, Schouten EJ, Makombe SD, Yu JK, and Harries AD
- Subjects
- Adolescent, Antitubercular Agents therapeutic use, Child, Child, Preschool, Female, Follow-Up Studies, HIV Infections mortality, Humans, Infant, Malawi, Male, Retrospective Studies, Survival Rate, Treatment Outcome, Tuberculosis drug therapy, Anti-HIV Agents therapeutic use, HIV Infections complications, HIV Infections drug therapy, Tuberculosis complications
- Abstract
Setting: Mzuzu Central Hospital, in the northern region of Malawi, which provides free antiretroviral therapy (ART) to human immunodeficiency virus (HIV) infected adults and children, including those with tuberculosis (TB)., Objectives: To compare outcomes in HIV-infected children who have been started on ART because of 1) active TB, 2) a past history of TB in the last 2 years and 3) a non-TB diagnosis., Design: Retrospective data collection using ART patient master cards and ART patient registers., Results: Between July 2004 and September 2006, 439 (11%) children of a total 3908 patients were started on ART. There were 29 with active TB, 56 with a past history of TB in the last 2 years and 354 with a non-TB diagnosis. The three groups were similar in nutritional indices and CD4-lymphocyte percentages. The 6-month probability of survival was 0.86 in the active TB group, 0.94 in the past history of TB group and 0.89 in the non-TB group. 12-month survival probability for the same groups was 0.86, 0.86 and 0.88, respectively., Conclusion: HIV-infected children with active and previous TB who are started on ART have good outcomes that are similar to those of children started on ART due to a non-TB diagnosis.
- Published
- 2007
28. Outcomes of tuberculosis patients who start antiretroviral therapy under routine programme conditions in Malawi.
- Author
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Makombe SD, Harries AD, Yu JK, Hochgesang M, Mhango E, Weigel R, Pasulani O, Fitzgerald M, Schouten EJ, and Libamba E
- Subjects
- Comorbidity, Humans, Malawi epidemiology, Treatment Outcome, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, HIV Infections epidemiology, Tuberculosis epidemiology
- Abstract
Setting: Public sector facilities in Malawi providing antiretroviral therapy (ART) to human immunodeficiency virus (HIV) positive patients, including those with tuberculosis (TB)., Objectives: To compare 6-month and 12-month cohort treatment outcomes of HIV-positive TB patients and HIV-positive non-TB patients treated with ART., Design: Retrospective data collection using ART patient master cards and ART patient registers., Results: Between July and September 2005, 7905 patients started ART, 6967 with a non-TB diagnosis and 938 with a diagnosis of active TB. 6-month cohort outcomes of non-TB and TB patients censored on 31 March 2006 showed significantly more TB patients alive and on ART (77%) compared with non-TB patients (71%) (P < 0.001). Between January and March 2005, 4580 patients started ART, 4179 with a non-TB diagnosis and 401 with a diagnosis of active TB. 12-month cohort outcomes of non-TB and TB patients censored on 31 March 2006 showed significantly more TB patients alive and on ART (74%) compared with non-TB patients (66%) (P < 0.001). Other outcomes of default and transfer out were also significantly less frequent in TB compared with non-TB patients., Conclusion: HIV-positive TB patients on ART in Malawi have generally good treatment outcomes, and more patients need to access this HIV treatment.
- Published
- 2007
29. Assessment of a national monitoring and evaluation system for rapid expansion of antiretroviral treatment in Malawi.
- Author
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Lowrance D, Filler S, Makombe S, Harries A, Aberle-Grasse J, Hochgesang M, and Libamba E
- Subjects
- Attitude of Health Personnel, Data Collection methods, HIV Infections epidemiology, Humans, Malawi epidemiology, Medical Records, Population Surveillance methods, Program Evaluation methods, Time Factors, Treatment Outcome, Anti-Retroviral Agents therapeutic use, Government Programs methods, HIV Infections drug therapy
- Abstract
Objectives: Monitoring and evaluation of national antiretroviral therapy (ART) programs is vital, but routine, standardized assessment of national ART patient monitoring systems has not been established. Malawi has undertaken an ambitious ART scale-up effort, with over 57,000 patients initiated on ART by June 2006. We assessed the national ART monitoring and evaluation system in Malawi to ensure that the response to the epidemic was being monitored efficiently and effectively, and that data collected were useful., Methods: The evaluation, performed in August 2005, generally followed the Updated Guidelines for Evaluating Public Health Surveillance Systems (CDC) and Interim Patient Monitoring Guidelines for HIV Care and ART (WHO). Assessment was conducted with qualitative methods, including twelve ART site visits, with standardized key informant interviews with ART clinic coordinators, clinical staff, and data managers, at each site. Meetings were also held with key governmental stakeholders, including Ministry of Health and National AIDS Commission., Results: The national monitoring and evaluation system devised by the Ministry of Health HIV/AIDS Unit is successful in achieving its objectives, and facilitates important aspects of the national response to HIV. Several basic changes in the data collection tools and system would facilitate more effective long-term assessment of the ART program and support improved patient care. As the number of ART sites and patients continues to expand, the current manual paper-based system may be overwhelmed. Identification and implementation of a feasible electronic data system that would maintain and improve data quality and the efficiency of data recording and reporting and enhance patient care is a priority., Conclusions: The assessment of ART monitoring and evaluation systems can optimize the effectiveness of national ART programs, and should be considered in other resource-constrained countries rapidly scaling up ART.
- Published
- 2007
- Full Text
- View/download PDF
30. Providing HIV care for tuberculosis patients in sub-Saharan Africa.
- Author
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Harries AD, Boxshall M, Phiri S, van Gorkom J, Zachariah R, Squire SB, Makombe SD, Kwanjana J, and Gondwett M
- Subjects
- Africa South of the Sahara, Antiviral Agents therapeutic use, HIV isolation & purification, HIV Infections complications, Humans, Trimethoprim, Sulfamethoxazole Drug Combination therapeutic use, Tuberculosis, Pulmonary complications, HIV Infections diagnosis, HIV Infections prevention & control, Infection Control organization & administration, Tuberculosis, Pulmonary drug therapy
- Abstract
Human immunodeficiency virus (HIV)/acquired immunedeficiency syndrome (AIDS) and tuberculosis (TB) cause an immense burden of disease in sub-Saharan Africa. A large amount of knowledge has been gathered in the last 15 years about the negative impact that HIV has on TB control, both at a programme level and at the level of the individual patient. Equally, interventions that are known to benefit patients have been tested and piloted, and these form important components of international TB-HIV guidelines, a TB-HIV strategic framework and an interim policy on TB-HIV coordination. Unfortunately, in sub-Saharan Africa there is little evidence that these interventions are being implemented on the ground, and one of the reasons for this paralysis is that the operational details are not well developed. This paper takes the three important HIV interventions of HIV testing and counselling, cotrimoxazole preventive treatment and antiretroviral treatment, and discusses some of the practical details of on-the-ground implementation. We hope that this will generate discussion, but above all, the impetus to start delivering services to patients.
- Published
- 2006
31. Risk factors for high early mortality in patients on antiretroviral treatment in a rural district of Malawi.
- Author
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Zachariah R, Fitzgerald M, Massaquoi M, Pasulani O, Arnould L, Makombe S, and Harries AD
- Subjects
- AIDS-Related Opportunistic Infections mortality, Adult, CD4 Lymphocyte Count, Cross-Sectional Studies, Female, HIV Infections complications, HIV Infections drug therapy, Humans, Malawi epidemiology, Male, Nutrition Disorders complications, Nutrition Disorders epidemiology, Risk Factors, Rural Health, Sex Distribution, Survival Analysis, Treatment Outcome, Anti-Retroviral Agents therapeutic use, HIV Infections mortality
- Abstract
Objectives: Among adults started on antiretroviral treatment (ART) in a rural district hospital (a) to determine the cumulative proportion of deaths that occur within 3 and 6 months of starting ART, and (b) to identify risk factors that may be associated with such mortality., Design and Setting: A cross-sectional analytical study set in Thyolo district, Malawi., Methods: Over a 2-year period (April 2003 to April 2005) mortality within the first 3 and 6 months of starting ART was determined and risk factors were examined., Results: A total of 1507 individuals (517 men and 990 women), whose median age was 35 years were included in the study. There were a total of 190 (12.6%) deaths on ART of which 116 (61%) occurred within the first 3 months (very early mortality) and 150 (79%) during the first 6 months of initiating ART. Significant risk factors associated with such mortality included WHO stage IV disease, a baseline CD4 cell count under 50 cells/mul and increasing grades of malnutrition. A linear trend in mortality was observed with increasing grades of malnutrition (chi for trend = 96.1, P = 0.001) and decreasing CD4 cell counts (chi for trend = 72.4, P = 0.001). Individuals who were severely malnourished [body mass index (BMI) < 16.0 kg/m] had a six times higher risk of dying in the first 3 months than those with a normal nutritional status., Conclusions: Among individuals starting ART, the BMI and clinical staging could be important screening tools for use to identify and target individuals who, despite ART, are still at a high risk of early death.
- Published
- 2006
- Full Text
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32. Who is accessing antiretroviral therapy during national scale-up in Malawi?
- Author
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Makombe S, Libamba E, Mhango E, de Ascurra Teck O, Aberle-Grasse J, Hochgesang M, Schouten EJ, and Harries AD
- Subjects
- Adolescent, Adult, Aged, Child, Child, Preschool, Delivery of Health Care statistics & numerical data, Female, Humans, Infant, Infant, Newborn, Malawi, Male, Middle Aged, Occupations statistics & numerical data, Antiretroviral Therapy, Highly Active statistics & numerical data, HIV Infections drug therapy, Patient Acceptance of Health Care statistics & numerical data
- Abstract
Malawi is scaling-up provision of free antiretroviral therapy (ART) in the public sector. In the fourth quarter of 2004 and the first quarter of 2005, 3261 and 4530 new patients, respectively, were started on ART. Of these patients, approximately 40% were male and 95% were adults aged > or =13 years. The age group data show that women who accessed ART were in general 10 years younger than men. Between 84% and 90% of patients were started on ART because of being clinically assessed as being in WHO stages III or IV, with the remainder started on ART owing to a low CD4 lymphocyte count. The number of tuberculosis (TB) patients started on ART was 351 (11% of ART patients) in the fourth quarter of 2004 and 702 (15% of ART patients, and 16% of registered TB patients) in the first quarter of 2005. Twenty-nine pregnant women were referred to ART from prevention of mother-to-child transmission programmes in the first quarter of 2005. Between 56% and 62% of patients were subsistence farmers, housewives or in business. Steady progress is being made with national scale-up, although more attention needs to be directed to children, pregnant women and patients with TB to improve their access to ART.
- Published
- 2006
- Full Text
- View/download PDF
33. Scaling up antiretroviral therapy in Africa: learning from tuberculosis control programmes--the case of Malawi.
- Author
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Libamba E, Makombe S, Harries AD, Chimzizi R, Salaniponi FM, Schouten EJ, and Mpazanje R
- Subjects
- AIDS-Related Opportunistic Infections epidemiology, Africa South of the Sahara epidemiology, Directly Observed Therapy, HIV Infections epidemiology, Humans, Malawi epidemiology, Prevalence, Treatment Outcome, Tuberculosis epidemiology, Tuberculosis prevention & control, AIDS-Related Opportunistic Infections drug therapy, Antiretroviral Therapy, Highly Active standards, Communicable Disease Control organization & administration, HIV Infections drug therapy
- Abstract
The rapid and massive scale-up of antiretroviral drug therapy (ART) so needed in sub-Saharan Africa will not be possible using a 'medicalised' model. A more simple approach is required. DOTS has been used now for many years to provide successful anti-tuberculosis treatment to millions of patients in poor countries of the world, and many of the established concepts can be used for the delivery of ART. Malawi, a small and impoverished country in sub-Saharan Africa, is embarking on a national scale-up of ART. In this review we describe how we have adopted several of the principles of DOTS for delivering ART in Malawi: case finding and registration, treatment, monitoring, drug procurement, staffing and the issue of free drugs. We also discuss ART for HIV-infected TB patients. We hope that by using the DOTS approach we will be able to deliver ART to large numbers of HIV-infected patients under controlled conditions, and minimise the risk of developing drug resistance.
- Published
- 2005
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